Hostname: page-component-6dbcb7884d-lhnfz Total loading time: 0 Render date: 2025-02-14T03:48:43.663Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Extended-Spectrum Beta-Lactamase–Producing Klebsiella Pneumoniae in a Neonatal Intensive Care Unit Linked to Artificial Nails

Published online by Cambridge University Press:  02 January 2015

Archana Gupta ,
Phyllis Della-Latta ,
Betsy Todd ,
Pablo San Gabriel ,
Janet Haas ,
Fann Wu ,
David Rubenstein  and
Lisa Saiman
Archana Gupta
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Phyllis Della-Latta
Affiliation:
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York
Betsy Todd
Affiliation:
Department of Epidemiology, Columbia University, New York-Presbyterian Hospital, New York, New York
Pablo San Gabriel
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Janet Haas
Affiliation:
School of Nursing, Columbia University, New York-Presbyterian Hospital, New York, New York
Fann Wu
Affiliation:
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York
David Rubenstein
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York
Lisa Saiman*
Affiliation:
Department of Pediatrics, Columbia University, New York-Presbyterian Hospital, New York, New York Department of Epidemiology, Columbia University, New York-Presbyterian Hospital, New York, New York
*
Department of Pediatrics, Columbia University, 622 West 168th Street PH4 West Rm. 470, New York, NY 10032
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

From April to June 2001, an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae infections was investigated in our neonatal intensive care unit.

Methods:

Cultures of the gastrointestinal tracts of patients, the hands of healthcare workers (HCWs), and the environment were performed to detect potential reservoirs for ESBL-producing K. pneumoniae. Strains of K. pneumoniae were typed by pulsed-field gel electrophoresis using Xbal. A case–control study was performed to determine risk factors for acquisition of the outbreak clone (clone A); cases were infants infected or colonized with clone A and controls (3 per case) were infants with negative surveillance cultures.

Results:

During the study period, 19 case-infants, of whom 13 were detected by surveillance cultures, harbored clone A. The overall attack rate for the outbreak strain was 45%; 9 of 19 infants presented with invasive disease (n = 6) or developed invasive disease (n = 3) after colonization was detected. Clone A was found on the hands of 2 HCWs, 1 of whom wore artificial nails, and on the designated stethoscope of a case-infant. Multiple logistic regression analysis revealed that length of stay per day (odds ratio [OR], 1.05; 95% confidence interval [CI95], 1.02 to 1.09) and exposure to the HCW wearing artificial fingernails (OR, 7.87; CI95, 1.75 to 35.36) were associated with infection or colonization with clone A.

Conclusion:

Short, well-groomed, natural nails should be mandatory for HCWs with direct patient contact.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 210 - 215
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hart, C. Klebsiella and the neonate. J Hosp Infect 1993;23:83–86.CrossRefGoogle Scholar
2.Podschun, R, Fischer, A, Ullman, U. Expression of putative virulence factors by clinical isolates of Klebsiella planticola. J Med Microbiol 2000;49:115–119.Google Scholar
3.Knothe, H, Shah, P, Krcmery, V, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315–317.CrossRefGoogle ScholarPubMed
4.Lebessi, E, Dellagrammaticus, H, Tassios, PT, et al. Extended-spectrum beta-lactamase-producing K. pneumoniae in a neonatal intensive care unit in the high-prevalence area of Athens, Greece. J Clin Microbiol 2002;40:799–804.Google Scholar
5.Adler, JL, Shulman, JA, Terry, PM, Feldman, DB, Skaliy, P. Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae, types 2 and 11, in a premature nursery. J Pediatr 1970;77:376–385.Google Scholar
6.Coovadia, YM, Johnson, AP, Bhana, RH, Hutchinson, GR, George, RC, Hafferjee, IE. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. J Hosp Infect 1992;22:197–205.Google Scholar
7.Royle, J, Halasz, S, Eagles, G, et al. Outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae in a neonatal unit. Arch Dis Child Fetal Neonatal Ed 1999;80:F64–F68.CrossRefGoogle Scholar
8.Lin, H. Antibiotic resistance in bacteria: a current and future problem. Adv Exp Med Biol 1999;455:387–396.Google Scholar
9.Flaherty, JP, Weinstein, RA. Nosocomial infection caused by antibiotic-resistant organisms in the intensive-care unit. Infect Control Hosp Epidemiol 1996;17:236–248.Google Scholar
10.Goldmann, DA, Huskins, WC. Control of nosocomial antimicrobial-resistant bacteria: a strategic priority for hospitals worldwide. Clin Infect Dis 1997;24(suppl 1):S139–S145.Google Scholar
11.Larson, EL, Hughes, CA, Pyrek, JD, Sparks, SM, Cagatay, EU, Bartkus, JM. Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1998;26:513–521.Google Scholar
12.National Committee for Clinical Laboratory Standards. Performance of Standards for Antimicrobial Susceptibility Testing: Twelfth Informational Supplement. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002:22. M100–S12.Google Scholar
13.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14.Stone, PW, Gupta, A, Loughrey, M, et al. Attributable costs of an extended spectrum beta-lactamase Klebsiella pneumoniae outbreak in a NICU. Infect Control Hosp Epidemiol 2003;24:601–606.CrossRefGoogle Scholar
15.Gaynes, RP, Edwards, JR, Jarvis, WR, et al. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.Google Scholar
16.Stoll, BJ, Gordon, T, Korones, SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the NICHD Neonatal Research Network. J Pediatr 1996;129:63–71.Google Scholar
17.Sohn, AH, Garett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in the neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–827.Google Scholar
18.Philippon, A, Labia, R, Jacoby, G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1989;33:1131–1136.Google Scholar
19.Macrae, MB, Shannon, KP, Rayner, DM, Kaiser, AM, Hoffman, PN, French, GL. A simultaneous outbreak on a neonatal unit of two strains of multiply antibiotic resistant Klebsiella pneumoniae controllable only by ward closure. J Hosp Infect 2001;49:183–192.Google Scholar
20.Jacoby, G. Epidemiology of extended-spectrum beta-lactamases. Clin Infect Dis 1998;27:81–83.Google Scholar
21.Schiappa, DA, Hayden, MK, Matushek, MG, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli blood stream infection: a case-control and molecular epidemiology investigation. J Infect Dis 1996;174:529–536.Google Scholar
22.Pena, C, Pujols, M, Ardunay, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended spectrum beta-lactamases. Antimicrob Agents Chemother 1998;42:53–58.CrossRefGoogle ScholarPubMed
23.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.CrossRefGoogle ScholarPubMed
24.Piroth, L, Aube, H, Diose, J, Vincent-Martin, M. Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: are beta-lactamase inhibitors of therapeutic value? Clin Infect Dis 1998;27:76–80.CrossRefGoogle ScholarPubMed
25.Venezia, RA, Scarano, FJ, Preston, KE, et al. Molecular epidemiology of an SHV-5 extended-spectrum beta-lactamase in Enterobacteriaceae isolated from infants in a neonatal intensive care unit. Clin Infect Dis 1995;21:915–923.Google Scholar
26.Pessoa-Silva, CL, Meurer-Moreira, B, Camara-Almeida, V, et al. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: risk factors for infection and colonization. J Hosp Infect 2003;53:198–206.CrossRefGoogle Scholar
27.Pottinger, J, Burns, S, Manske, C. Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17:340–344.Google Scholar
28.Edel, E, Houston, S, Kennedy, V, LaRocco, M. Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel. Nurs Res 1998;47:54–59.Google Scholar
29.Wynd, CA, Samstag, DE, Lapp, AM. Bacterial carriage on the fingernails of OR Nurses. AORN J 1994;60:796–805.Google Scholar
30.Hedderwick, SA, McNeil, SA, Lyons, MJ, Kauffman, CA. Pathogenic organisms associated with artificial fingernails. Infect Control Hosp Epidemiol 2000;21:505–509.Google Scholar
31.Winslow, EH, Jacobson, AF. Can a fashion statement harm the patient? Am J Nurs 2000;100:63–65.Google Scholar
32.Moolenaar, RL, Crutcher, M, San Joaquin, VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21:80–85.Google Scholar
33.Foca, M, Jakob, K, Whittier, S, et al. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343:695–700.Google Scholar
34.Passaro, DJ, Waring, L, Armstrong, R, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992–995.Google Scholar
35.Parry, MF, Grant, B, Yukna, M, et al. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 2001;32:352–357.Google Scholar
36.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1–S46.Google Scholar
37.Saiman, L, Lerner, A, Saal, L, et al. Banning artificial nails from health care settings. Am J Infect Control 2002;30:252–254.Google Scholar